Patient: Male, 22Final Diagnosis: Lemierre’s syndromeSymptoms: Dyspnea • chest pain • swellingMedication: —Clinical Procedure: ThoracentesisSpecialty: Infectious DiseasesObjective:Rare co-existance of disease or pathologyBackground:Lemierre’s syndrome (LS) is a rare syndrome caused by an acute oropharyngeal infection with metastatic spreading. It was described in 1939 as jugular vein septic thrombophlebitis associated with retropharyngeal infection. Different organisms can cause LS, such as Fusobacterium species, Peptostreptococcus, group B and C, Streptococcus, Staphylococcus, and Enterococcus species, but the most commonly isolated pathogen is Fusobacterium necrophorum, a common oral flora. Management depends on the initial presentation, type of pathogen isolated, and proper selection of antibiotics.Case Report:We report a case of a 22-year-old man with no past medical history, who presented with left jaw pain and progressive left facial area swelling associated with dyspnea. A final diagnosis of LS was made based on criteria of computed tomography (CT) of the neck and the clinical symptoms. The patient was started on broad-spectrum antibiotics. Subsequent imaging of the chest showed pleural effusion with septic emboli. He underwent thoracentesis and chest tube placement. Final blood cultures were remarkable for gram-negative rods – Prevotella anaerobes – which supported the diagnosis of LS. His condition improved, including the dyspnea, and he was discharged on the proper antibiotics coverage with outpatient follow-up.Conclusions:LS is a rare condition associated with metastatic infection spreading. This syndrome can be associated with further complications, such as pleural effusions and/or empyemas. Early recognition is important to prevent fatal complications and provide adequate antibiotics coverage. We report only the third case in the medical literature of Prevotella-induced LS with a secondary complication of pleural effusion.
Cardiovascular diseases are the leading cause of death in the USA. Moreover, hypertension affects approximately 78 million people in the USA and is a major modifiable risk factor. Therefore, elevated blood pressure is listed as the primary contributory cause of death in 15 % of the 2.4 million deaths in 2009. Nonetheless, 44 % of the hypertensive population in the USA did not have it under control in 2014. Hypertension cost was averaged to be 40-50 billion dollars yearly including medications and services and currently rising. New hypertension guidelines recommend treating individuals between ages 35 and 74 with different stages of hypertension. Furthermore, individuals with existing co-morbidities such as chronic kidney disease and diabetes should have increased medication adherence and different blood pressure goal compared to those without co-morbidities. Studies utilizing quality-adjusted life-years (QUALYs) were conducted to asses the cost-effectiveness of treating previously untreated adults with hypertension. On average, treating adults between ages 35 to 74 years could prevent about 50,000 and 13,000 cardiovascular events and deaths, respectively. Overall, treating stage 1 and 2 hypertension adults including emphasis on medication adherence could be effective and cost saving. The purpose of this article is to review different methods and assess cost-effectiveness for hypertension therapy based on the 2014 guidelines.
Edoxaban is a factor Xa inhibitor that is approved for prevention of stroke in individuals with atrial fibrillation and treatment of venous thromboembolic disease at once daily 60 mg dose for individuals with normal renal function. A decrease of dose to 30 mg is recommended for those with moderate renal insufficiency, weight ≤ 60 kg or simultaneous administration of strong P-glycoprotein inhibitors. At this time, it is not recommended for use in persons with either end stage renal disease or with GFR exceeding 95 mL/min. Shorter half-life averaging 8-10 hours may translate into a safer profile. With a fast onset of action of ~1.5 hours and relatively high bioavailability, edoxaban is an alternative for patients who may not be good candidates for warfarin therapy due to multiple limitations that vitamin K anticoagulation entails. No clear benefits of edoxaban have been reported to date compared to the other available factor Xa inhibitors.
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